Background: Although sacroiliac joint dysfunction (SIJD) is generally regarded as a source of lumbar pain, its anatomical position and the absence of a diagnostic ‘gold standard’ lead to difficulties at examination and differential diagnosis. However, since sacroiliac (SI) joint blocks only provide information about pathologies of joint origin and since SIJD developing secondary to pathologies in structures around the joint can be missed. Provocation and palpation tests also need to be used in diagnosis. Objectives: The purpose of this study was to examine the reliability of clinical examination and provocation tests used in the diagnosis of SIJD. Study Design: Retrospective analysis of prospectively collected data. Setting: Outpatient physical medicine and rehabilitation clinic. Methods: One hundred and seventeen patients presenting with lumbar and/or leg pain and diagnosed with SIJD through clinical evaluation were included in the study. Range of lumbar joint movement, pain location and specific tests used in the diagnosis of SIJD were evaluated. Positivity in 3 out of 6 provocation tests was adopted as the criterion. Results: 75.2% of patients were female and 24.8% were male. Mean age was 46.41 ± 10.45 years. A higher level of females was determined in ender distribution. SIJD was determined on the right in 52.6% of patients and on the left in 47.4%. When SI joint provocation tests were analyzed individually, the highest positivity, in 91.4% patients diagnosed with SIJD, was in the FABER test. The lowest positivity, in 56.4% of patients, was determined in the Ganslen test. The same patients were assessed by the same clinician at 2 different times. In these data, the simple consistence, kappa and PABAK coefficient values of all tests were close to 1 and indicating good agreement. The thigh thrust (POSH) and sacral thrust tests exhibited very good agreement with a kappa coefficient of 0.90 and a PABAK coefficient of 0.92, while the FABER test exhibited good agreement with a kappa coefficient of 0.78 and a PABAK coefficient of 0.92. Limitation: Agreement between different observers was not evaluated, and also no comparison was performed with SI joint injection, regarded as a widely used diagnostic technique. Conclusion: The anatomical position of the SI joint and the lack of a diagnostic ‘gold standard’ make the examination and diagnosis of SIJD difficult. Most SI joint clinical tests have limited reliability and validity on their own, while a multitest regimen consisting of SI joint pain provocation tests is a reliable method, and these tests can be used instead of unnecessary invasive diagnostic SI joint procedures. Key words: Dysfunction, lumbar, sacroiliac joint, provocation test, sacroiliac joint pain, pain pattern
Study Design. A prospective cross-sectional study. Objective. To evaluate the prevalence of sacroiliac joint dysfunction in patients with lumbar disc hernia and examine the variations in clinical parameters cause by this combination. Summary of Background Data. Although one of the many agents leading to lumbar pain is sacroiliac dysfunction, little progress has still been made to evaluate mechanical pain from sacroiliac joint dysfunction within the context of differential diagnosis of lumbar pain. Methods. Two hundred thirty-four patients already diagnosed with lumbar disc hernia were included in the study. During the evaluation, sacroiliac joint dysfunction was investigated using specific tests, pain levels with a Visual Analog Scale, and the presence of neuropathic pain using Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Other clinical assessments were performed using the Beck Depression Inventory, Health Assessment Questionnaire, and Tampa Kinesiophobia Scale. Results. 63.2% of patients were female and 36.8% were male. Mean age was 46.72 ± 11.14 years. The level of sacroiliac joint dysfunction was 33.3% in the research population. In terms of sex distribution, the proportion of women was higher in the group with sacroiliac joint dysfunction (P < 0.05). No significant difference was observed in pain intensity assessed using a Visual Pain Scale between the groups (P > 0.05), but the level of neuropathic pain was significantly higher in the group with dysfunction (P < 0.05). In the group with sacroiliac joint dysfunction, the presence of depression was significantly higher (P = 0.009), functional capacity was worse (P < 0.001), and the presence of kinesophobia was higher (P = 0.02). Conclusion. Our study results will be useful in attracting the attention of clinicians away from the intervertebral disc to the sacroiliac joint in order to avoid unnecessary and aggressive treatments. Level of Evidence: 2
It was with great interest that we read the article by Jonathan P. Eskander et al '"Value of Examination Under Fluoroscopy for the Assessment of Sacroiliac Joint Dysfunction" published in the 2016 March/July issue of Pain Physician (1). This is a well-designed prospective article which demonstrates that a positive result was considered as more than 2 hours of greater than 75% reduction in visual analog scale scores with local anesthesia injection guided by fluoroscopy, the gold standard technique for the diagnosis of sacroiliac joint dysfunction syndrome.
Background Lateral epicondylitis (LE) is one of the most common conditions affecting elbow [1]. Primary aims of treatment are pain relief and restoration of muscle condition [2]. There is a wide spectrum of treatments used in daily practice for management of LE such as analgesic medications, physical therapy, exercise and orthoses. Despite the large number of trials undertaken on LE, no treatment has been proven to be universally effective or generating consensus on its management [3]. Objectives The aim of this study was to determine and compare the efficacy of TENS and kinesiotaping (KT) treatments in LE. Methods In this prospective-randomised, assessor blinded controlled trial; 78 patients (63 women, 15 men, mean age 47,5±7,94 years) with LE were enrolled. Patients were allocated into 4 treatment groups, for a duration of 10 days. Group 1 received TENS +KT, group 2 received TENS+sham KT, group 3 received sham TENS+KT and group 4 received shamTENS+sham KT. All patients were given a progressive exercise regimen and were informed about the disease. Outcome measures were pain-free grip strength, pressure pain threshold and pain severity at rest, night and forced wrist extension test. Patient rated tennis elbow evaluation (PRTEE) was used to determine the functional status. Patients were assessed for the outcome measures at the 10th day and 12 th week of the follow up period. Results At day 10, TENS, KT and TENS+KT combination treatments were statistically superior to sham group in primary outcome measures (P<0.05). At week 12, all groups including sham treatments had statistically significant improvements compared to pre-treatment, however there were no significant differences among groups. Conclusions To our knowledge, this is the first study evaluating TENS and KT in LE. In this study we found that TENS, KT and TENS+ KT combination therapies have positive effects on pain, function and quality of life in acute management of LE. However these positive changes in acute period could not be sustained at week 12. This may be attributed to the self-limiting nature of the disease over time [4–6] or to the positive effects of advice about activities and exercise programme at the sham group. Further research is needed to confirm these results. References Randall L. Braddom. Physical Medicine and Rehabilitation. Elsevier Health Sciences, 2010;835-836 Vincenzino B. Lateral epicondylalgia: a musculoskeletal physiotherapy perspective. Man Ther 2003;8:68–79. Bisset L, Paungmali A, Vicenzino B, Beller E. A systematic review and meta-analysis of clinical trials on physical interventions for lateral epicondylalgia. Br J Sports Med 2005;39(7):411-22. Cyriax JH. The pathology and treatment of tennis elbow. J Bone Joint Surg 1936;18:921-38. Hudak PL, Cole D, Haines T. Understanding prognosis to improve rehabilitation: the example of lateral elbow pain. Arch Phys Med Rehabil 1996;77:586-93. Murtagh JE. Tennis elbow. Aust Fam Physician 1988;17:90,91,94-5. Disclosure of Interest : None declared DOI 10.1136/...
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